Rise In Hemoglobin Research Articles

#4740 DIFFERENT ORAL IRON PREPARATIONS IN CHRONIC KIDNEY DISEASE: A COMPARATIVE ANALYSIS

Abstract Background and Aims Anaemia is common and undertreated morbidity in chronic kidney disease (CKD). Optimal approach to treatment of renal anemia is matter of ongoing debate. This is the first comparative analysis between different oral iron preparations in CKD patients. Method This prospective observational multicentre study was performed from March 2019 to May 2021. In total, 214 non-dialysis dependent CKD stage3-5 patients with 3 months follow-up were included. Inclusion & exclusion criteria are mentioned in Table 1. Primary outcome was rise in Haemoglobin at 1 month/3 months & rise in Transferrin saturation (TSAT) at 3 months. Treatment adherence was also evaluated. Figure 1 depicts the study model. Results Table 2 depicts demographic data while Table 3 depicts correlation between baseline haemoglobin & different modifiable/non-modifiable variables. Rise in haemoglobin & TSAT with different oral iron preparations has been shown in Table 4 while the ANOVA tables for clinical significance of this rise has been shown in Figures 2 & 3. Rise in haemoglobin and TSAT% was highest with Ferric Pyrophosphate > Ferric Fumarate > Ferric Saccharate. Treatment adherence was highest with Ferric Pyrophosphate (100%) > Heme Iron Polypeptide (91.4%) > Ferrous Ascorbate (88.9%). Conclusion Ferric Pyrophosphate is most effective among available oral iron preparations in rising haemoglobin level. It effectively repletes iron stores & has highest treatment adherence.

Clinical outcomes by SF3B1 mutation status in patients (pts) with lower-risk myelodysplastic syndrome (LR-MDS) retreated with erythropoiesis-stimulating agents (ESAs).

7071 Background: Pts with SF3B1-mutated LR-MDS often have a more favorable prognosis versus those with SF3B1 wildtype. A sizeable number of pts with LR-MDS undergo ESA treatment even after experiencing ESA failure in first line. This study evaluated the outcomes of pts with LR-MDS retreated with ESAs in routine clinical practice, stratified by SF3B1 status. Methods: This retrospective cohort study included pts with LR-MDS in the US community setting who initiated ESAs as first-line therapy between January 1, 2016 and June 30, 2019, and were followed through June 30, 2021. Eligible pts discontinued ESAs (treatment gap ≥ 3 wk for epoetin alfa or ≥ 6 wk for darbepoetin alfa) and subsequently reinitiated ESA therapy at least once during follow-up. Ring sideroblasts (RS) ≥ 15% served as a surrogate for pts with unknown SF3B1 mutation status. Outcomes included ESA switches, dose reductions and escalations, ESA failure, and overall survival (OS). Primary ESA failure was defined as no rise in hemoglobin (Hb) ≥ 1.5 g/dL or no decrease in RBC transfusion requirement by 8 wk of treatment. Transfusion-dependent (TD) status was evaluated for pts who were transfusion independent (TI) at baseline. Results: A total of 82 pts with LR-MDS and repeat ESA treatment were included. Median age at start of ESA treatment was 79 y (interquartile range [IQR], 72–85). Diagnosis of MDS-RS, MDS with isolated del(5q), MDS with multilineage dysplasia, and MDS with single lineage dysplasia was reported in 30 (36%), 7 (9%), 9 (11%), and 9 (11%) pts, respectively; 27 (33%) had unknown classification. Median follow-up was 26 mo (IQR, 13–38) with 65% failing ESA therapy by 8 wk. Table shows pts’ SF3B1 mutation status, median OS, pts who had an ESA switch, dose reduction or escalation, experienced ESA failure, and pts who were TI at baseline and became TD during follow-up. Results were similar when RS was not used as a surrogate, and when analyses were limited to pts who were treated with ESAs only throughout follow-up. Conclusions: In this study of pts with LR-MDS retreated with ESAs, primary ESA failure was high with nearly half of TI pts becoming TD during follow-up. OS was poor regardless of SF3B1 status – 2–4 times lower than the remaining life expectancy for a 79-y-old (108 mo for men; 125 mo for women). Although treatment options were limited during the study period, the high primary failure rate suggests that pts with LR-MDS may benefit from alternatives to ESAs. [Table: see text]

CARC4: Incidence, Outcomes, and Risk Factors of Acute Kidney Injury in Patients on Percutaneous Mechanical Circulatory Support with Impella 5.0 and 5.5 for Cardiogenic Shock

Purpose: Use of temporary mechanical circulatory devices (tMCS) such as the transaxial flow pump (ImpellaTM. Abiomed, Danvers, MA) for CS-HF is growing. Despite advances in tMCS investigations have found AKI is highly prevalent and strongly associated with mortality in CS patients supported with MCS. We identified pre and post implant risk factors of AKI in CS-HF patients supported with Impella 5.0 and 5.5. Methods: Single center retrospective analysis of 144 Impella 5.0/5.5 devices from 01/2012 to 07/2022 for CS-HF. Patients with non heart failure etiology (n=5) and pre-implant renal replacement therapy (RRT. n=44) were excluded. Demographics and pre-implant chacteristics of patients) as well as post-implant outcomes including mortality, heart replacement therapy (HRT) with ventricular assist device (VAD) or heart transplant (HTX), and native heart survival at discharge were compared between patients with and without acute kidney injury (AKI). AKI was defined as rise in Creatinine 1.5 x baseline or new need for RRT. Logistic regression was used to find independent predictors of post-implant AKI and spearmann correlation was used to find associations with 90-day kidney function defined as fold change in creatine from baseline to peak 90 day values). Results: The final cohort consisted of 96 patients with mean duration of Impella support of 10±12 days.. Of the remaining 96 devices 57 (59.4%) developed AKI with 9 requiring RRT (9.4%). Patients with AKI had higher mortality (42.1% vs 17.9%, p=0.04), lower HRT (43.9% vs 56.4%, p=0.04) and less native heart survival (discharged without HRT) (14.0% vs 25.6%, p=0.04) than those without AKI. Demographics and pre-implant characteristics are shown in in Table 1. Pre-implant creatinine, lactate dehydrogenase (LDH), total bilirubin, Model for End Stage Liver Disease (MELD), and mean right atrial pressure to pulmonary capillary wedge pressure (mRAP/PCWP) as well as post-implant hemolysis (rise in plasma free hemoglobin > 20 or LDH 2.5 x upper limit of normal) were higher in patients with AKI. On logistic regression with backwards selection independent predictors of AKI included pre-implant mRAP/PCWP (OR 33.5 95%CI 1.6-708.8, p=0.02) and post-implant hemolysis (OR 5.6 95%CI 2.1-31.5, p=0.045) (Table 2). On spearman correlation (Table 3) only pre-implant mRAP/PCWP and post-implant LDH:Upper limit of normal LDH were associated with worse long term kidney function defined as fold change of 90-day peak creatinine from baseline. Conclusions: AKI is associated with higher mortality after Impella 5.0 and 5.5 insertion. The etiology of AKI in patients with cardiogenic shock supported by Impella 5.0 and 5.5 is multifactorial but clearly related to venous congestion and hemolysis. Optimization of patient’s fluid status when the device is inserted and avoidance of hemolysis during device support play key roles in reducing AKI in this group of high risk patients.

Effect of voxelotor on cardiopulmonary testing in youths with sickle cell anemia in a pilot study.

Individuals with sickle cell anemia (SCA) exhibit decreased exercise capacity. Anemia limits oxygen-carrying capacity and affects cardiopulmonary fitness. The drug voxelotor raises hemoglobin in SCA. We hypothesized that voxelotor improves exercise capacity in youths with SCA. In a single-center, open-label, single-arm, longitudinal interventional pilot study (NCT04581356), SCA patients aged 12 and older, stably maintained on hydroxyurea, were treated with 1500mg voxelotor daily, and performed cardiopulmonary exercise testing before (CPET#1) and after voxelotor (CPET#2). A modified Bruce Protocol was performed on a motorized treadmill, and breath-by-breath gas exchange data were collected. Peak oxygen consumption (peak VO2 ), anaerobic threshold, O2 pulse, VE/VCO2 slope, and time exercised were compared for each participant. The primary endpoint was change in peak VO2 . Hematologic parameters were measured before each CPET. Patient Global Impression of Change (PGIC) and Clinician Global Impression of Change (CGIC) surveys were collected. Ten hemoglobin SS patients aged 12-24 completed the study. All demonstrated expected hemoglobin rise, with average +1.6g/dL (p=.003) and P50 left shift of average -11mmHg (p<.0001) with decreased oxygen off-loading at low pO2 . The change in % predicted peak VO2 from CPET#1 to CPET#2 ranged from -12.8% to +11.3%, with significant improvement of more than 5% in one subject, more than 5% decrease in five subjects, and insignificant change of less than 5% in four subjects. All 10 CGIC and seven of 10 PGIC responses were positive. In a plot study of 10 youths with SCA, voxelotor treatment did not improve peak VO2 in 9 out of 10 patients.

Effect of Educational Handouts With Standard Therapy Versus Standard Therapy Alone on Compliance With Oral Iron Supplementation in Antenatal Women With Iron Deficiency Anemia: A Randomized Controlled Trial.

Background Iron requirements rise dramatically throughout the second and third trimesters of pregnancy. Pregnant women are more susceptible to anemia because their needfor iron increases during pregnancy, which is difficult to achieve through diet alone. Methodology A randomized controlled trial (non-blinded and parallel group) was undertaken with the recruitment of 174 women. However, 35 women were lost to follow-up, and the study was ultimately completed with 139 participants distributing 68 women in Group A (intervention group) and 71 women in Group B (non-interventional group). Educational handouts were explained to the participants with iron supplements in Group A and only supplements were given to Group B, and the participants were followed up till three months before the recruitment period. Compliance with iron supplementation and a rise in hemoglobin were noted. Results In this study, maximum women were in the 22-30 years age group and were almost evenly distributed with respect to parity with no statistically significant difference in the groups. All the participants were started with oral iron therapy. No additional parenteral iron therapy was given. Women in Group A showed good compliance for iron supplementation than those in Group B. It was determined that this difference was statistically insignificant (>0.05). In the majority of women, the reason for poor compliance was frustration to follow oral iron therapy daily (52.3% in Group A and 21.7% in Group B). There were other reasons like forgetfulness, heartburn, vomiting, constipation, and nausea as the reason for poor compliance. The hemoglobin levels were compared at the recruitment and a mean rise in hemoglobin levels was noted in groups A and B at the follow-up period after three months. There was a greater mean rise in hemoglobin concentration in Group A (1.28) than in Group B (0.63), which was statistically insignificant (>0.05). Conclusion The current study found that among pregnant women with iron-deficient anemia, instructional handouts did not promote compliance with oral iron treatment. The main reasons for low compliance were frustration with taking the oral drug, followed by forgetfulness, heartburn, vomiting, constipation, and nausea. In pregnant females with anemia brought on by iron deficiency, educational handouts did not enhance hemoglobin status.

Polycythemia among Patients with Chronic Obstructive Pulmonary Disease Admitted to the Department of Medicine in a Tertiary Care Center: A Descriptive Cross-sectional Study

Chronic obstructive pulmonary disease is a preventable and treatable disease marked by persistent airflow limitation. Abnormal rise of haemoglobin and/or hematocrit in peripheral blood is known as polycythemia which includes increased haemoglobin: greater than 16.5 g/dl in men or greater than 16.0 g/dl in women and increased hematocrit: >49% for men and >48% for women. Men, current smoking, impaired carbon monoxide diffusing capacity, severe hypoxemia, and high altitude living are risk factors associated with an increased risk for secondary polycythemia. Polycythemia contributes to the development of cor-pulmonale and pulmonary hypertension, which are linked to poor prognosis. This study aimed to find out the prevalence of polycythemia among patients with chronic obstructive pulmonary disease admitted to the department of medicine in a tertiary care centre. A descriptive cross-sectional study was conducted among patients with chronic obstructive pulmonary disease admitted to the Department of Medicine in a tertiary care centre after receiving ethical approval from Institutional Review Committee (Reference number: 153/079/080). The study was conducted from 15 September 2022 to 2 December 2022. Data were collected from the hospital records. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 185 patients, Polycythemia was seen in 8 (4.32%) (1.39-7.25, 95% Confidence Interval) patients among which 7 (87.5%) were females and 1 (12.5%) were male. The prevalence of polycythemia was lower compared to other similar studies done in similar settings. chronic obstructive pulmonary disease; polycythemia; prevalence.

Early glomerular filtration rate decline is associated with hemoglobin rise following dapagliflozin initiation in heart failure with reduced ejection fraction

Introduction and objectivesSodium-glucose cotransporter-2 inhibitors (SGLT2i) induce short-term changes in renal function and hemoglobin. Their pathophysiology is incompletely understood. We aimed to evaluate the relationship between 1- and 3-month estimated glomerular filtration rate (eGFR) and hemoglobin changes following initiation of dapagliflozin in patients with stable heart failure with reduced ejection fraction (HFrEF). MethodsThis is a post hoc analysis of a randomized clinical trial that evaluated the effect of dapagliflozin on 1- and 3-month peak oxygen consumption in outpatients with stable HFrEF (DAPA-VO2 trial, NCT04197635). We used linear mixed regression analysis to assess the relationship between eGFR and hemoglobin changes across treatment arms. ResultsA total of 87 patients were evaluated in this substudy. The mean age was 67.0± 10.5 years, and 21 (24.1%) were women. The mean baseline eGFR and hemoglobin were 66.9±20.7mL/min/1.73m2 and 14.3±1.7g/dL, respectively. Compared with placebo, eGFR did not significantly change at either time points in the dapagliflozin group, but hemoglobin significantly increased at 1 and 3 months. At 1 month, the hemoglobin increase was related to decreases in eGFR only in the dapagliflozin arm (P <.001). At 3 months, there was no significant association in either treatment arms (P=.123). Changes in eGFR were not associated with changes in peak oxygen consumption, quality of life, or natriuretic peptides. ConclusionsIn patients with stable HFrEF, 1-month changes in eGFR induced by dapagliflozin are inversely related to changes in hemoglobin. This association was no longer significant at 3 months.

Altitude Pre-Acclimatization with an Erythropoiesis-Stimulating Agent.

High altitude illness is a complication of rapid ascent above 2,500 m elevation. Ventilatory, circulatory and haematological adjustments, known as acclimatization, occur to maintain adequate delivery of oxygen. Although (non-)pharmaceutical strategies that modulate ventilation and circulation have long been accepted, the haematological approach has not. This report describes the application of a comprehensive strategy, including prior pre-acclimatization using an erythropoiesis-stimulating agent (ESA), in two healthy subjects ascending from sea level to 6,268 m. Following ESA administration 30 days prior to ascent, the subjects had a cumulative haemoglobin rise of 7.1% and 11.9%, respectively. Both subjects experienced minimal symptoms during four incremental ascents to the final altitude and no adverse events occurred. This report has limited external validity, lacking both a sample size and controls, but can serve as practical exploration of the concept. Administration of an ESA may be a safe and useful pre-acclimatization strategy but cannot be recommended based on current evidence. More comprehensive research is needed. High altitude illness (HAI) is a debilitating syndrome with potentially lethal consequences caused by ascent to a hypobaric atmosphere without acclimatization.Pharmacological strategies aimed at increasing oxygen delivery may be used to prevent and treat HAI.Administration of an erythropoiesis-stimulating agent may be a safe and useful pre-acclimatization strategy but cannot be recommended based on current evidence alone.

A Community-Based Trial on The Comparison of Efficacy, Safety and Cost Effectiveness of Ferrous Sulphate and Ferrous Ascorbate for Anaemia in Pregnancy In Madhya Pradesh, India

Background: Anaemia has significant impact on health of the fetus as well as that of mother. Increased need of iron during pregnancy especially after 2nd trimester makes iron supplementation mandatory. Ferrous ascorbate is known to exist intact inside the gastrointestinal tract due to the stable chelation of iron with ascorbate. This compound does not dissociate due to any of the food inhibitors. The aim is to study the effectiveness of Ferrous Ascorbate and Ferrous sulphate in terms of compliance and cost effectiveness of management of anaemia in pregnancy. Methodology: Study design: Quasi Experimental study, Study area: District Vidisha, Study participants: Pregnant women of first trimester registered during the study period in the selected Anganwadis/ Gram Arogya Kendra (GAK), Sample size: 240 antenatal mothers. Results: Baseline mean haemoglobin was 11.31±1.05 gm/dl. The mean increase in Ferrous Sulphate was 0.55 gm/dl, and in Ferrous ascorbate was 1.27 gm/dl. Ferrous Sulphate was less compliant than Ferrous ascorbate, and has higher efficacy and lesser side effects. Only Rs. 10.2 additional cost per antenatal mothers for increase of ≥1gm% in Hb will be borne by government if Ferrous Sulphate is replaced by Ferrous Ascorbate. Conclusions: Study results show statistically significant difference in rise of haemoglobin amongst the antenatal mothers consuming Ferrous ascorbate over Ferrous Sulphate.

COMPARING EFFICACY OF SODIUM FEREDETATE AND FERROUS ASCORBATE IN THE TREATMENT OF ANEMIA IN ANTENATAL WOMEN

Aim: Type of Study : To compare efcacy and side effects of Sodium Feredetate and Ferrous Ascorbate Prospective ,randomized, comparative clinical study 50 antenatal women with haemoglobin be Materials and methods : tween 8-10 gm % attending the out patient department divided into groups of 2 by randomization were treated with ferrous ascorbate (100mg elemental Iron ) and Sodium feredetate (33 mg elemental Iron ) for 30 days. Haemoglobin and ferritin estimation was done on day 0 and day 30 There Results : was signicant and comparable rise in haemoglobin and serum Ferritin in both the groups on day 30 Lower doses of elemental iron – Conclusion : Sodium Feredetate (33 mg elemental Iron) per day produce similar rise in haemoglobin levels as compared to ferrous ascorbate (100 mg elemental Iron) per day

A Phase 2 Randomized Controlled Trial of Single-Agent Hydroxyurea Versus Thalidomide Among Adult Transfusion Dependent β Thalassemia Patients.

The online version contains supplementary material available at 10.1007/s12288-022-01620-3.

Effect of Iron and Folic Acid supplementation among nutritionally anemic women of reproductive age in rural Maharashtra: Acommunity-based intervention study

Background: In the context of the limited effectiveness of daily iron supplementation in national programs, intermittent iron supplementation is currently under debate as a possible alternative. Objective: To study the outcome of twice weekly iron supplementation compared to daily supplementation. Methods: A community-based interventional study was carried out in 283 women of the 15-49 years age group who were not pregnant and not lactating at the initiation of the study. For intervention purpose, women with mild and moderate anemia were taken. In two schedules, an interventional drug (100 mg elemental iron with 0.5 mg folic acid) was given for three months. In the daily schedule, one tablet every day; and in the weekly schedule, two tablets once a week on a fixed day were given. Result: Out of 283 anemic participants, 141 received daily while 142 received weekly iron and folic acid supplementation. Post intervention, the weekly iron supplementation group revealed that, proportion of anemia cases reduced to the tune of 32.4% and the mean increase in hemoglobin level was 1.42 gm/dl (SD ± 0.77). In contrast, in patients who had a daily supplementation regimen, the mean increase in hemoglobin level was 1.78 gm/dl (SD ± 0.83). Conclusion: Result of present study shows that, effect of daily Iron and Folic Acid (IFA) supplementation to raise hemoglobin level was higher as compared to weekly IFA supplementation. But weekly supplementation when considered separately also had significant effect to raise the hemoglobin level. It is observed that, there is no statistically significant difference in the rise of hemoglobin in both the groups, signifying weekly iron therapy as effective role as daily iron therapy in reducing anemia

Treating Complications of Extracorporeal Life Support in a Patient with COVID-19 (Case Report)

We present a case of mechanical hemolysis as a complication of extracorporeal membrane oxygenation (ECMO) occurring in a COVID-19 patient as a result of pump head thrombosis. After emergency extracorporeal circuit replacement, hemoadsorption was initiated to address the negative hemolysis effects and plasma free hemoglobin rise in the setting of rapid clinical deterioration and impaired renal function. During therapy hemolysis severity reduced, the lactate dehydrogenase (LDH) levels decreased, while the P/F ratio increased two-fold. The patient was discharged from hospital on day 54 without the need for either oxygen therapy or dialysis. In the discussion section we addressed frequent issues of choosing therapy for ECMO complications.Conclusion. The timely, properly chosen, and clinically relevant use of hemoadsorption combined with advanced high-technology therapeutic procedures can have a positive impact on the patient's outcome.

The combined effect of zinc and honey to increase hemoglobin and albumin levels in white rats induced by low protein diet

&lt;p&gt;&lt;span&gt;Undernutrition is a type of malnutrition. Malnutrition can endanger human life, particularly that of children. Honey, which has a high nutritional value, is one of the components that can be utilized to alleviate malnutrition. Zinc tablets, in addition to honey, are thought to boost hemoglobin (Hb) and albumin levels. Zinc, as an antioxidant and catalyst for biochemical events, aids in organ healing, particularly by restoring the role of enzymes in the process of food metabolism in the body. This study was conducted as an experimental study with a pretest-posttest design and a control group. Thirty Wistar rats were randomly distributed into six groups of five rats. The average Hb and albumin levels in the group of rats differ significantly, both in the single treatment and the combination of normal rats and malnutrition control. The groups that were given zinc and honey once a day had the greatest rise in hemoglobin, which was 0.5 g/dl (3.10%). The groups who received zinc and honey twice a day had the greatest rise in albumin (1.99 g/dl) (163.11%).&lt;/span&gt;&lt;/p&gt;

Iron Infusions, Their Reactions and Efficacy Related to Dosing - a Single Center Retrospective Study

Background: Intravenous (IV) iron infusions are associated with a variety of adverse drug reactions (ADRs) including anaphylactic reactions. The Commonly used IV iron formulations are Iron sucrose (Venofer), Ferric carboxymaltose (Injectafer), Sodium ferric gluconate complex (Ferrlecit), and others. Iron sucrose has been approved by the FDA (Food and Drug Administration) for patients with iron deficiency who also have kidney disease. It is also often used off-label for iron deficiency anemia on its own. In our facility, multiple ADRs were noted with Venofer compared to other formulations. Hence, we aimed to study: 1. If altering the dose of Venofer will result in a lesser incidence of allergic reactions. 2. To determine if one preparation of IV iron has a higher incidence of adverse events than another. 3. To evaluate the efficacy after 6 to 8 weeks of completion of iron infusions, by comparing the response to various dosages and formulations. Methods: This is a retrospective chart review of 274 patients ages 18-92 who received at least one dose of Intravenous Iron at Einstein Medical Center Montgomery Outpatient Infusion Center from 01/01/21 to 10/31/21. Patients were divided into two groups based on the Venofer dosing schedule. Group D1 included patients that received any IV iron formulation from January to May 2021. In this group, Venofer dosing was 400mg x 1 followed by 300mg x2. Multiple ADRs were noticed in group D1 hence Group D2 was created. This group included patients that received any IV iron formulation from June to October 2021, where Venofer dosing was changed to 300mg x 3 doses or 300mg x 2 followed by 400mg. We collected data on age, gender, race, preparation, strength, pregnancy status, prior history of allergies and transfusion reactions, adverse drug reactions, the timing of reaction, total doses received, pre/post-medications provided to prevent or treat a reaction, outcomes of reaction, hemoglobin, iron studies before and after the infusions. Patient characteristics in both D1 and D2 groups were well balanced. Data were analyzed and summarized in descriptive measures. Efficacy of intravenous iron treatment was measured as a rise in Hemoglobin by 2gm/dl. Results: Out of 120 patients in group D1, 71 patients (59.2%) received Injectafer, out of these, 12 patients (16.9%) had ADRs, the most common reaction was hypotension, and 1 patient had an anaphylactic reaction requiring Emergency Room (ER) visit. Responders in this group were 28/71(39.4%). 10/71 (14.1%) were lost to follow-up. 48 patients (40%) received Venofer, out of which 11 patients (22.9%) had ADRs, the most common being pain in the back, and 2 patients required ER visits. Responders to the infusion in this group were 11/48 (22.9%) with 10/48 (20%) lost to follow-up. 1 patient (0.8%) received ferumoxytol, with no ADRs to report. In the D2 group, which involved a total of 154 patients, 76 patients (49.3%) received Injectafer, out of which 14 patients (18.4%) had ADRs, again the most common being hypotension, and 2 patients required an ER visit. Responders in this group were 29/76 (38.1%) and 10/76 (13.2%) were lost to follow-up. 77 patients (50%) received Venofer, out of which 9 patients (11.7%) had ADRs, the most common being hypotension and this group has not had any ER visits. Responders to the infusion in this group were 36/77(46.8%) and 9/77 (11.7%) were lost to follow-up. 1 patient (0.6%) received Ferumoxytol with no ADRs. [See Table 1]. Conclusions: Injectafer was overall the most used iron formulation in our institution. It was associated with more ADRs when compared to Venofer, including anaphylactic reactions. The most common ADR was hypotension with Injectafer, and back pain with Venofer. We found that Venofer dosing with 400mg x 1 followed by 300mg x2 was associated with the highest incidence of ADRs. Both strategies of Venofer dose modification with 300mg x 3 and schedule modification, 300x 2 followed by 400mg had greater efficacy and lesser frequency of ADRs as compared to Venofer 400mg followed by 300mg x2. Other studies have shown the benefit of Venofer in non-renal disease patients with iron deficiency. Although our study was not planned to demonstrate this outcome, our data may suggest that Venofer is beneficial for this group of patients. This should be looked into with further studies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effect of Mobile Phone Call Reminders With Standard Therapy Versus Standard Therapy Alone on Compliance With Iron Supplementation in Antenatal Women With Iron Deficiency Anemia: A Randomized Controlled Trial.

IntroductionIn spite of the implementation of the National nutritional anemia prophylaxis program in India, the prevalence of anemia during pregnancy is 50 in 100 women. One main cause for the high frequency of anemia among antenatal women in India is a lack of iron consumption. Few studies are available in the literature where efforts have been made to improve compliance with iron therapy. In the same line of thinking, it was decided in the present study to use mobile phone calls as a reminder for iron tablets.MethodThe present study is a randomized controlled open-label trial. Antenatal women with gestational age between 13-28 weeks of pregnancy diagnosed with iron deficiency anemia (Hb - 8 to 11 gm/dl) having mobile phones were included in the study. Recruited women were randomized into two groups of study groups receiving standard therapy with the addition of fortnightly mobile phone call reminders and a control group receiving standard therapy alone.ResultsCompliance with iron supplementation was observed higher in the study group as compared to the control group (range of 48% to 93%). There was a mean hemoglobin rise in both the groups at the time of delivery compared with the hemoglobin at the time of recruitment (Study group- 9.74 to 10.69, Control group- 9.48 to 10.06). There was a statistically higher (0.00001) increase in the mean hemoglobin concentration in the study group (0.96 gm/dl) as compared to the control group (0.59 gm/dl). The reasons for poor compliance were boredom with taking daily oral iron therapy (66.66%), constipation (3.7%), forgetfulness (14.81%), and heartburn (14.81%). There was no statistical difference in the reason for poor compliance with iron supplementation in both groups.ConclusionThe present study concludes that mobile phone call reminders along with standard therapy with iron supplementation improve compliance with iron supplementation and lead to a greater rise in hemoglobin in antenatal women with iron deficiency anemia.

Treatment Efficacy of Oral and Intravenous Iron Delivery Routes for Anemic Pregnant Women

Background: Although it particularly is prevalent in less-developed countries, anemia in pregnancy remains a significant problem in the developed world. It is one of the major health issues during pregnancy. The principle cause of anemia is iron deficiency, which is dependent on the patient's dietary status. Treatment of iron deficiency anemia is critically essential during pregnancy to prevent bad maternal and neonatal outcomes Objective: The study aimed to compare the oral and intravenous iron delivery routes in anemic pregnant women. Study design: It is an experimental study. The 120 patients who visited the gynecology department of the hospital for the duration of one year from June 2021 to May 2022 were selected. Material and Methods: The data was taken from 120 patients that were admitted in Department of Obstetrics and Gynecology of Sindh Government Hospital Landis, The duration of study was one year. All the patients were aware of the study, as written consent was taken from them. The oral iron intake was given to 58 women and to the other 62 women the intravenous injections of iron was administrated during their pregnancy. All the participants completed their follow-up sessions throughout the year. The blood samples and the other data related to pregnancy was collected from each patient. Results: The back-count of tablets was carried out and it was observed that almost 89% women took their iron supplements daily. There were only 5% patients that took 50% of their iron tablets. The average dose that was given to women was 600mg in case of elemental intravenous iron. The average level of iron and ferritin are observed to be higher in the group administrated with intravenous injection as compared to the other group. The chances of hemoglobin rise were more in case of intravenously administered patients. Conclusion: The study was carried out to compare the oral and intravenous iron delivery routes in anemic pregnant women. It was found that intravenous delivery route of iron in form of iron sucrose is safe and an effective method for the iron therapy in anemic pregnant women, as it restores the hemoglobin stores efficiently as compared to other group. However, it is costly as it need hospitalization. As an alternative oral iron can also be used if the women has severe iron deficiency in the third trimester. Keywords: Intravenous iron delivery routes and anemic pregnant women.

Delayed haemolytic transfusion reaction due to Kidd antibodies.

A delayed haemolytic transfusion reaction (DHTR) encompasses a positive direct antiglobulin test (DAT) developed anytime between 24 hours to 28days after cessation of transfusion, a positive eluate or a newly identified alloantibody in the plasma or serum along with features of haemolysis in the patient. Routinely, it is expected that with the transfusion of one unit of packed red cells in a patient of average height and weight, the haemoglobin level and hematocrit increase by 1 g/dL and 3% respectively. However, in a patient with DHTR, an inadequate rise of post-transfusion haemoglobin (<1g/dL) or rapid fall in haemoglobin back to pre-transfusion levels is observed. Kidd antibodies are particularly known to cause DHTR, maybe alone or in unison with other antibodies. Detection of these alloantibodies is consequential in providing good transfusion support to these patients. These events may be difficult to detect as they may present as varied clinical features or immunological nuisances. In this case series, we have presented three cases of DHTR with special emphasis on their clinical presentations, immunohaematological evaluations, laboratory parameters and the role of proper transfusion support in these patients to avoid further complications.

Parenteral vs Oral Vitamin B12 in Children With Nutritional Macrocytic Anemia: A Randomized Controlled Trial

There is limited literature in children on efficacy of different routes of vitamin B12 administration for vitamin B12 deficiency macrocytic-megaloblastic anemia. To compare parenteral with oral vitamin B12 therapy in children with macrocytic-megaloblastic anemia. Single-center, open-label randomized controlled trial. 80 children aged 2 month-18 year with clinical and laboratory features of nutritional macrocytic anemia. All children received an initial single parenteral dose of 1000 µg vitamin B12 followed by randomization to either parenteral or oral vitamin B12 for subsequent doses. Group A was given 1000 µg intramuscular (IM) vitamin B12 (3 doses on alternate days for those aged <10 year, five doses for age >10 year), followed by monthly 1000 µg IM for the subsequent two doses. Group B was given daily oral vitamin B12 1500 µg (500 µg in <2 years age) for three months. Folic acid and iron supple-mentation, and relevant dietary advice were given to both groups in a similar fashion. Improvement in serum vitamin B12 levels and total hemoglobin was compared three months post-treatment. The median(IQR) increase in serum vitamin B12 level was significantly higher in group A [600 (389,775) vs 399 (313, 606) pg/mL; P= 0.016]. The median (IQR) rise of hemoglobin was also more in group A [2.7 (0.4,4.6) vs 0.5 (-0.1,1.2) g/dL; P=0.001]. Increase in serum vitamin B12 levels and hemoglobin was better in children with nutritional macrocytic anemia receiving parenteral as compared to oral vitamin B12.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist